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Hyperfractionated Versus Conventionally Fractionated Radiotherapy in Standard Risk Medulloblastoma (SIOP-PNET-4)

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ClinicalTrials.gov Identifier: NCT01351870
Recruitment Status : Active, not recruiting
First Posted : May 11, 2011
Last Update Posted : February 12, 2020
Sponsor:
Information provided by (Responsible Party):
Institut Curie

Study Description
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Brief Summary:
This is an international prospective randomised trial, which will compare two radiotherapy regimens in children and adolescents (aged 4 or 5 years to 21 years inclusive) with carefully staged 'standard risk' medulloblastoma.

Condition or disease Intervention/treatment Phase
Medulloblastoma Radiation: Standard Fractionation Regimen Radiation: Hyperfractionated Radiotherapy Phase 3

Detailed Description:
Patients eligible for the study will be those with non-metastatic medulloblastoma (by imaging and CSF cytology) at diagnosis. Patients randomised to the standard arm will receive conventionally fractionated (once a day) radiotherapy with a dose of 54 Gy to the posterior fossa and 23.4 Gy to the craniospinal axis. The experimental arm will be hyperfractionated (twice a day) radiotherapy (1 Gy b.d.) with a dose of 60 Gy to the posterior fossa with an additional 8 Gy to the tumour bed and 36 Gy to the craniospinal axis. Both groups will receive identical chemotherapy consisting of eight weekly doses of Vincristine given with radiotherapy and 8 courses of CCNU, cisplatin and vincristine following radiotherapy.
Study Design
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Study Type : Interventional  (Clinical Trial)
Actual Enrollment : 52 participants
Allocation: Randomized
Intervention Model: Parallel Assignment
Masking: None (Open Label)
Primary Purpose: Treatment
Official Title: A Prospective Randomised Controlled Trial of Hyperfractionated Versus Conventionally Fractionated Radiotherapy in Standard Risk Medulloblastoma
Study Start Date : April 2004
Actual Primary Completion Date : December 2008
Estimated Study Completion Date : February 2021

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Arms and Interventions
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Arm Intervention/treatment
Active Comparator: Standard Fractionation Regimen

1.8 Gy daily, 5 fractions per week

Cranio-spinal axis:

23.4 Gy in 13 fractions of 1.8 Gy

Posterior fossa:

30.6 Gy in 17 fractions of 1.8 Gy

 Radiation: Standard Fractionation Regimen

1.8 Gy daily, 5 fractions per week

Cranio-spinal axis:

23.4 Gy in 13 fractions of 1.8 Gy

Posterior fossa:

30.6 Gy in 17 fractions of 1.8 Gy
Experimental: Hyperfractionated radiotherapy

1 Gy b.d. (minimum interval between fractions 8 hours). 10 fractions per week

Craniospinal axis:

36 Gy in 36 fractions of 1 Gy

Posterior fossa:

24 Gy in 24 fractions of 1 Gy

Tumour Bed:

8 Gy in 8 fractions of 1 Gy

 Radiation: Hyperfractionated Radiotherapy

1 Gy b.d. (minimum interval between fractions 8 hours). 10 fractions per week

Craniospinal axis:

36 Gy in 36 fractions of 1 Gy

Posterior fossa:

24 Gy in 24 fractions of 1 Gy

Tumour Bed:

8 Gy in 8 fractions of 1 Gy


Outcome Measures
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Primary Outcome Measures :
  1. Free survival rate [ Time Frame: 2 years after the start of the study ]
    To compare in a randomised trial the event free survival rate for children and adolescents with standard risk medulloblastoma treated with either hyperfractionated radiotherapy or reduced dose radiotherapy with conventional fractionation.


Secondary Outcome Measures :
  1. To compare overall survival between the two treatment arms. [ Time Frame: Follow-up of the last patient included up to the age of 20 years ]
    Will hyperfractionated radiotherapy lead to a different progression free (PFS) and overall survival (OS) compared to the standard arm radiotherapy?

  2. To compare the pattern of relapse between the two treatment arms [ Time Frame: Follow-up of the last patient included up to the age of 20 years ]
    Will hyperfractionated RT lead to a different pattern of local tumour control/pattern of relapse with particular respect to local relapse (tumour bed, posterior fossa outside the tumour bed) compared to the standard arm RT? The time to local progression should be the measure for the local tumour control.

  3. To explore the benefit and the risks of neurosurgery [ Time Frame: Follow-up of the last patient included up to the age of 20 years ]

    To determine the toxicity of surgery.To investigate whether there are identifiable factors that correlate with toxicity.

    To define the impact of any complications of surgery on commencement of adjuvant therapy and on EFS.



Eligibility Criteria
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Ages Eligible for Study:   4 Years to 22 Years   (Child, Adult)
Sexes Eligible for Study:   All
Accepts Healthy Volunteers:   No
Criteria

Inclusion Criteria:

  • Age at diagnosis at least 4 years or 5 years (according to the policy of the National Brain Tumour Group) and less than 22 years.
  • Histologically proven medulloblastoma, including the following variants(WHO classification - 2000): classic medulloblastoma, nodular / desmoplastic medulloblastoma, melanotic medulloblastoma, medullomyoblastoma No CNS metastasis on MRI - supratentorial, arachnoid of the posterior fossa or spine.
  • No clinical evidence of extra-CNS metastasis
  • No tumour cells on the cytospin of lumbar CSF. Central Review of CSF cytology is recommended but not mandatory. It will be left to national policy.
  • Radiotherapy to start no more than 40 days after surgery.
  • Ability to receive twice daily radiotherapy.
  • Vital functions within normal range for their age group.
  • CTC grades < 2 for liver, renal, haematological and audiological function.
  • No medical contraindication to radiotherapy or chemotherapy.
  • Written informed consent (and patient assent where appropriate) according to the laws of each participating country. Written informed consent should also be sought for biological studies.
  • National and local ethical committee approval according to the laws of each participating country (to include approval for biological studies).

Exclusion Criteria:

  • One of the inclusion criteria is lacking.
  • Brainstem or supratentorial primitive neuroectodermal tumour.
  • Atypical teratoid rhabdoid tumour.
  • Medulloepithelioma.
  • Ependymoblastoma.
  • Large cell médulloblastoma.
  • Metastatic medulloblastoma (on CNS MRI and/or positive cytospin of postoperative lumbar CSF).
  • Patient previously treated for a brain tumour or any type of malignant disease.
  • Patients who are pregnant.
  • Females who are sexually active and not taking reliable contraception.
  • Known predisposition to medulloblastoma e.g. Gorlin's syndrome.
Contacts and Locations
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Information from the National Library of Medicine

To learn more about this study, you or your doctor may contact the study research staff using the contact information provided by the sponsor.

Please refer to this study by its ClinicalTrials.gov identifier (NCT number): NCT01351870


Locations
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France
Institut Curie
Paris, France, 75005
Sponsors and Collaborators
Institut Curie
Investigators
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Principal Investigator: DOZ François, MD Institut Curie
More Information
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Publications automatically indexed to this study by ClinicalTrials.gov Identifier (NCT Number):

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Responsible Party: Institut Curie
ClinicalTrials.gov Identifier: NCT01351870    
Other Study ID Numbers: IC2003-06 PNET4
First Posted: May 11, 2011    Key Record Dates
Last Update Posted: February 12, 2020
Last Verified: February 2020
Additional relevant MeSH terms:
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Medulloblastoma
Glioma
Neoplasms, Neuroepithelial
Neuroectodermal Tumors
Neoplasms, Germ Cell and Embryonal
 Neoplasms by Histologic Type
Neoplasms
Neuroectodermal Tumors, Primitive
Neoplasms, Glandular and Epithelial
Neoplasms, Nerve Tissue